Sterilisation of s-nitrosothiols

ABSTRACT

This invention provides a method of sterilising an S-nitrosothiol, for example S-nitrosoglutathione, without reduction of purity by more than about 5.0% through degradation. The invention allows sterile S-nitrosothiol or a sterile pharmaceutical pre-composition comprising S-nitrosothiol, wherein the S-nitrosothiol is in dry solid form, to be produced. The sterile pharmaceutical pre-composition is mixed with one or more diluents, excipients, carriers, additional active agents, or any combination thereof, for example sterile saline, to prepare a pharmaceutical composition of S-nitrosothiol for use.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. Ser. No. 15/561,196,filed Sep. 25, 2017 as the U.S. National Stage of International PatentApplication No. PCT/GB2016/050772, filed Mar. 21, 2016, each of which ishereby incorporated by reference in its entirety, and which claimspriority to United Kingdom Patent Application No. 1505347.3, filed Mar.27, 2015.

FIELD OF THE INVENTION

The present invention relates to sterile S-nitrosothiols and sterilepharmaceutical pre-compositions containing S-nitrosothiols, which can bemade up into a sterile pharmaceutical composition with one or moresterile pharmaceutical diluents, excipients, carriers, additional activeagents, or any combination thereof, as desired, for pharmaceutical orveterinary use. The present invention also relates to a process for theproduction of the sterile materials without substantial loss ofS-nitrosothiol purity, and to kits and methods for preparing theready-to-use pharmaceutical compositions.

BACKGROUND OF THE INVENTION

S-nitrosothiols, namely molecules having the basic structure R—S—N═O,where R is any organic group, e.g., S-nitrosoglutathione (GSNO),S—NO-cysteine (S—NO-Cys), S-nitroso-N-acetylpenicillamine (SNAP), andnitroso derivatives of proteins such as albumin and haemoglobin (Hb),for example SNO-albumin and poly-SNO-albumin, exert nitric oxide-likeactivity in vivo. They cause arterial and venous smooth musclerelaxation, inhibit platelet aggregation, and activate guanylate cyclase(Rees et al., 1989b, Rees et al., 1989a), (Rees et al., 2001), (Radomskiet al., 1992). They are also involved, for example, inimmunosuppression, neurotransmission, and host defence.

Vasoactive S-nitrosothiols are known to be generated in vivo (Keaney etal., 1993), (Stamler et al., 1992), (Al-Sa'doni et al., 2000). The totalS-nitrosothiols in plasma has been reported to range from 40 nM to 7 μMin humans and rodents under non-inflammatory conditions (Stamler et al.,1992). S-nitrosothiol compounds can release nitric oxide when requiredvia reactions with transition metal ions or other reducing agents. Theyare envisioned as a buffering system that controls intra- andextra-cellular activities of NO, and magnify the range of its action.Once formed, S-nitrosothiols can directly transfer the nitrosyl cation(NO⁺) to another thiol via the so-called transnitrosation reaction,which ensures the dynamic state of S-nitrosothiols in vivo (Singh etal., 1996a; Singh et al., 1996b), (Butler et al., 1997).

S-nitrosoglutathione (GSNO)

is in clinical development as a pharmaceutical composition for human orveterinary therapy or prophylaxis.

S-nitrosothiols are sensitive to air, temperature, moisture andelectromagnetic radiation, and require careful storage and handling toavoid degradation (Singh et al., 1995), (Stamler et al., 2002), (Manojet al., 2009), (Parent et al., 2013). Nevertheless, even under strictlycontrolled air, radiation and temperature conditions, long term storageof S-nitrosothiols, as required for pharmaceutical products, results indegradation. For pharmaceutical use, this instability poses seriousproblems in terms of the purity of the active agent and compliance withpharmaceutical grade requirements, as well as accuracy andpredictability of the dosing of the active agent. Upon storage underinert atmosphere (argon and nitrogen) at −20° C. and in the dark,S-nitrosoglutathione, stored as a solid, has only been reported to bestable for 6 months (Parent et al., 2013). Upon storage under furthercontrolled air, radiation and temperature conditions,S-nitrosoglutathione, prepared by a specific method said to impartstability in solid form, has only been reported to be stable for 9months (Looker et al., 2008); (WO 2008/153762, Example 3 of thereference).

Liquid formulations of S-nitrosothiols are even more unstable anddecompose quantitatively in hours, such that only about 85% of theinitial S-nitrosoglutathione is present after at least 8-12 hoursfollowing storage at 4° C. to 25° C. (Looker et al., 2008); (WO2008/153762).

Although S-nitrosothiols, for example S-nitrosoglutathione, areattractive for treating a variety of diseases, solid oral doseformulations are unsuitable, as they decompose rapidly underphysiological conditions and are not able to deliver sufficientquantities of the active moiety, NO, to the desired location forextended periods of time or in a controlled manner. Parenteralinjectable solutions offer a suitable form of administration andcontinuous infusion allows sufficient quantities of S-nitrosothiols toreach the desired location rapidly for extended periods of time and in acontrolled manner. The extreme labile nature of S-nitrosothiols, such asS-nitrosoglutathione, in solution prevents formulation directly as a“ready to use liquid dosage form”. As such, the solution would need tobe made up immediately (extemporaneously) from the S-nitrosothiol soliddry particles, prior to administration.

Parenteral dosage forms differ from all other dosage forms in that theymust be sterile (absent of viable micro-organisms) and free fromphysical, chemical, and biological contaminants as they are administeredby injection, infusion or implantation directly into the human or animalbody. The pharmaceutical grade requirements for sterilisation ofS-nitrosothiol parenteral products pose significant commercialdevelopment problems.

So-called final-filter devices for intravenous (IV) administrationinclude filters attached to the end of the tubing of an IVadministration set for removing particulates and some microorganismssuch as bacteria or fungi by filtration immediately prior to entry intothe IV needle for administration. The use of filters having porositiesin the sub-0.5-μm region (e.g. 0.22 μm) enables, in principle, bacteriaand fungi to be removed. However, the use of final-filter devicescarries associated problems. Firstly, some bacteria and fungi, that arenot uniformly sized or spherical, could pass through the filtermembrane, as could viruses and mycoplasmas. In addition, when lowconcentrations of a drug are present in the solution for injection,absorption of the drug onto the filter membrane can lead to inadvertentunderdosing of drug. Furthermore, fine filters when wet cannot pass airexcept under elevated pressure, which can lead to retention of airbubbles in the tubing during set-up and a consequent risk of injectionof air to the patient during use when injection pressure is applied. Theuse of final-filter devices increases equipment costs, it creates a needfor a constant supply of specialised consumables, and it creates arequirement for special training of regular healthcare personnel or theemployment of specialists. Finally, regulatory authorities requirestringent controls of this procedure and do not consider it as providinga sterile parenteral solution but only a step that would removeparticulate matter.

The European Medicines Agency (EMA) has published guidelines for theselection of the most appropriate sterilisation method for a range ofmedicinal products. For dry powders, the preferred method according tothe guidelines is sterilisation by dry heat in the sealed finalcontainer (terminal sterilisation); however, for thermosensitivemedicinal products such as S-nitrosothiols, this sterilisation methodwould not be feasible, as the S-nitrosothiol would decompose. Analternative approach would be radiosterilisation (sterilisation byexposure to ionising electromagnetic radiation) (CPMP/QWP/054/98 corr).Sterilisation by irradiation also provides legal proprietary benefits todrug developers—the US Food and Drug Administration (FDA) categorisesdrugs which have been sterilised by irradiation as new drugs, meaningthat an approved new drug application is required for marketing (21 CFR310.502(a)(11)). However, S-nitrosothiols are also extremely sensitiveto electromagnetic radiation, being also highly labile following freeradical exposure. Indeed, an attempt to sterilise an injectableformulation of S-nitrosoglutathione within septum-sealed vials usinggamma radiation was apparently unsuccessful as it was reported that anunexpected inorganic nitrate impurity was generated (Lin, et al, 2005).Furthermore, sulphur amino acids (such as cysteine inS-nitrosoglutathione) have been reported to be particularly sensitive toirradiation leading to degradation at gamma radiation levels as low as 5kGy, possibly due to susceptibility to free radical attack (Ahn et al.,2002).

The sensitivity of S-nitrosothiols towards temperature and ionisingelectromagnetic radiation has hitherto prevented these methods beingconsidered as realistic or reliable for preparing sterile,pharmaceutical grade, S-nitrosothiols. Like all methods ofsterilisation, irradiation involves a compromise between inactivation ofthe contaminating microorganisms and damage to the product beingsterilised. The imparted energy, in the form of gamma photons orelectrons, does not particularly differentiate between molecules of thecontaminating microorganism and those of the pharmaceutical product.

For these reasons and others, effective simple sterilisation ofS-nitrosothiols such as, for example, S-nitrosoglutathione, in clinicalgrades of purity has been an insurmountable barrier, which has hinderedthe development of pharmaceutical uses of these potentially valuabledrugs in human and veterinary medicine.

The present invention is based on our surprising finding that ionisingradiation is effective to sterilise S-nitrosothiols with either noreduction in purity or a reduction in purity by not more than about 5.0%through degradation, so that these active agents, for example in theform of solid particles in a pre-metered dosage weight, preferably inmedical vials or similar containers, can be sterilised in clinicalgrades of purity.

SUMMARY OF THE INVENTION

The present invention is as defined in the appended claims.

The present invention provides in a first aspect a sterileS-nitrosothiol or a sterile pharmaceutical pre-composition comprisingS-nitrosothiol, wherein the S-nitrosothiol is in dry solid form.

The S-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol is preferably contained prior to use in a dry sterileenvironment such as, for example, in a sealed container. The seal may bea simple seal whereby the container can be opened, for example pierced,under sterile conditions to allow the sterile S-nitrosothiol or asterile pharmaceutical pre-composition comprising S-nitrosothiol to beformulated with one or more sterile pharmaceutical diluents, excipients,carriers, additional active agents, or any combination thereof, to makea final pharmaceutical composition for administration. The seal may bearranged, for example, so that a sterile liquid can be introduced intothe container, for example using a syringe provided with a hollowneedle, to dissolve or suspend the sterile dry solid S-nitrosothiol orthe sterile pharmaceutical pre-composition in situ within the container.A conventional septum seal is an example of such a seal. In that case,the seal may further permit the sterile pharmaceutical solution orsuspension thus formed to be withdrawn from the container foradministration to the patient, for example using a syringe provided witha hypodermic needle. For storage and transportation, the sealedcontainer containing the sterile dry solid S-nitrosothiol or the sterilepharmaceutical pre-composition can be provided with an impermeablesealing cap. Where a septum seal or the like is present which allowssterile liquid to be introduced and withdrawn from the sealed containerwithout loss of sterility of the contents of the container, animpermeable sealing cap may suitably be provided for transportation andstorage, to overlie the septum barrier or the like in conventionalmanner.

From this it will be seen that the expression “pharmaceuticalpre-composition” as used herein refers particularly to a precursor to apharmaceutical composition. The pharmaceutical pre-composition mayitself comprise, in addition to the one or more S-nitrosothiol, one ormore pharmaceutical diluents, excipients, carriers, additional activeagents, or any combination thereof. The pharmaceutical pre-compositionmay itself be usable as a pharmaceutical composition if a dry solidcomposition is sufficient for the intended administration route, butmore usually it is expected that the pharmaceutical pre-compositionwould be used to make up a final pharmaceutical compositionready-to-use, by mixture with one or more sterile pharmaceuticaldiluents, excipient, carriers, additional active agents, or anycombination thereof, as will be described in more detail below.

The sterile dry solid S-nitrosothiol or sterile pharmaceuticalpre-composition comprising sterile dry solid S-nitrosothiol, accordingto the first aspect of the present invention, is preferably obtained byexposing the dry solid S-nitrosothiol, or the pharmaceuticalpre-composition comprising the dry solid S-nitrosothiol, in non-sterileform to a sterilising dose of ionising radiation in an environmentsealed from external contamination. Such a method is new and constitutesa second aspect of the present invention. The exposure to the ionisingradiation preferably takes place when the S-nitrosothiol or thepharmaceutical pre-composition comprising S-nitrosothiol in non-sterileform is in the same dry environment as it will be stored and transportedprior to use, such as, for example, the sealed container described inrelation to the first aspect of the present invention.

The sealed container and the environment within it may suitably bearranged to minimise degradation of the S-nitrosothiol during storage ortransportation prior to use. For example, the walls of the sealedcontainer may be tinted (e.g. amber-tinted) or opaque to light, toreduce or eliminate photodegradation of the S-nitrosothiol. The drysterile environment within the sealed container may contain or consistof one or more of dry air, another dry gas such as, for example, a dryinert gas such as nitrogen, helium, argon, neon, xenon, krypton or amixture thereof, and it may optionally be under a reduced pressure incomparison with the external ambient air, to reduce or eliminate contactbetween the S-nitrosothiol and moisture and/or oxygen. The sealedcontainer may suitably contain a suitable desiccant in known manner tomaintain dry conditions, for example by absorbing any residual moisturesuch as water of crystallisation or atmospheric moisture introduced byone or more of the contents of the container. Suitable desiccants thatcan be used in the present invention are those that are pharmaceuticallysafe, and include, for example, pharmaceutical grades of silica gel,crystalline sodium, potassium or calcium aluminosilicate, colloidalsilica, anhydrous calcium sulphate and the like. The desiccant may bepresent in an amount from about 1.0% w/w to 20.0% w/w, or from about 2%w/w to 15% w/w, relative to the weight of S-nitrosothiol.

The sealed container may contain one or more oxygen scavengers in knownmanner.

The S-nitrosothiol containing material, both before and aftersterilisation, is suitably stored in the dark and exposed to light aslittle as possible. Tinted or light-opaque containers such asamber-tinted glass vials are conveniently used to contain the materialin dry form. Overwraps or pouches that are impermeable to oxygen andlight, for example aluminium pouches, may be used in known manner tofurther protect the S-nitrosothiol against degradation.

The dry solid S-nitrosothiol or the pharmaceutical pre-compositioncomprising dry solid S-nitrosothiol may suitably be present in thecontainer in a metered dose, for example, a known weight ofS-nitrosothiol selected according to an ultimate medical use.Instructions for mixing with a one or more sterile pharmaceuticaldiluents, excipients, carriers, additional active agents, or anycombination thereof—for example, a sterile liquid or paste or gel, suchas sterile saline, or other solid excipients or carriers—to obtain thepharmaceutical composition in a desired concentration for use maysuitably be provided. In a third aspect the present invention provides akit comprising a container or containers containing sterileS-nitrosothiol or a sterile pharmaceutical pre-composition comprisingS-nitrosothiol according to the first aspect of the invention togetherwith instructions for mixing the sterile S-nitrosothiol or a sterilepharmaceutical pre-composition comprising S-nitrosothiol with one ormore sterile pharmaceutical diluents, excipients, carriers, additionalactive agents, or any combination thereof, to obtain a pharmaceuticalcomposition for a pharmaceutical use containing S-nitrosothiol in adesired concentration.

When the sterile dry solid S-nitrosothiol or the sterile pharmaceuticalpre-composition comprising the sterile dry solid S-nitrosothiol isprepared by exposing dry solid S-nitrosothiol, or the pharmaceuticalpre-composition comprising dry solid S-nitrosothiol, in non-sterile formto a sterilising dose of ionising radiation in an environment sealedfrom external contamination, the resulting sterile material may containdead microbial cells killed by the ionising radiation and the nature andconcentration of any impurities will be characteristic ofradiosterilised S-nitrosothiol wherein the sterilisation is performed ondry solid material in accordance with the invention. The productsprepared or preparable by this process, as well as final pharmaceuticalcompositions made up from the sterile materials, can be identified inthis way.

The sterile dry solid S-nitrosothiol or the sterile pharmaceuticalpre-composition comprising sterile dry solid S-nitrosothiol may suitablyhave an S-nitrosothiol purity of at least about 95.0%, for example atleast about 98.0%, for example at least about 98.5%, for example atleast about 99.0%, for example at least about 99.5%. In the case of thesterile pharmaceutical pre-composition, “S-nitrosothiol purity” refersto the purity of the solid S-nitrosothiol material disregarding anyother components of the pharmaceutical pre-composition.

The dry solid S-nitrosothiol, whether alone or as part of apharmaceutical pre-composition, is preferably in particulate form, thatis, as a population of particles of S-nitrosothiol. The particles ofS-nitrosothiol may suitably comprise crystals.

The method of the second aspect of the present invention, comprisingexposing dry solid S-nitrosothiol, or a pharmaceutical pre-compositioncomprising dry solid S-nitrosothiol, in non-sterile form to asterilising dose of ionising radiation in an environment sealed fromexternal contamination, may be performed under conditions such thatthere is no reduction of the purity of the S-nitrosothiol or that itspurity is reduced by not more than about 5.0% through degradation. Thus,for example, starting from materials in which the S-nitrosothiol has apurity of about 99.5% purity, the conditions of the process should besuch that the reduction of S-nitrosothiol purity is not more than about1.5%, so that the sterile product has an S-nitrosothiol purity of atleast about 98.0%.

We have found that the purity of S-nitrosothiol in the solid drymaterial can be maintained to at least about 95.0%, and/or that any dropin purity of the S-nitrosothiol in the solid dry material can bemaintained to not more than about 5.0%, for example not more than about2.0%, for example not more than about 1.5%, when the temperature of theS-nitrosothiol is maintained not greater than about 40° C. during thesterilising exposure to the ionising radiation.

A suitable sterilising dose of the ionising radiation is an absorbeddose of up to about 50 kGy, up to about 35 kGy, up to about 25 kGy, upto about 15 kGy, or up to about 5 kGy to sterilise the S-nitrosothiol.In the method the S-nitrosothiol may, for example, be exposed to thesterilising dose of ionising radiation for a time period less than about24 hours; for example less than about 18 hours; for example less thanabout 12 hours; for example less than about 10 hours; for example lessthan about 6 hours; for example less than about 3 hours; for exampleless than about 2 hours; for example less than about 1 hour; for exampleless than about 45 minutes; for example less than about 30 minutes; forexample less than about 15 minutes; for example less than about 2minutes; for example less than about 1 minute; for example less thanabout 45 seconds; for example less than about 30 seconds.

In a fourth aspect the present invention provides a method for preparinga sterile pharmaceutical composition for human or veterinary use,comprising mixing the said sterile S-nitrosothiol or the sterilepre-composition containing S-nitrosothiol with one or more sterilepharmaceutical diluents, excipents, carriers, additional active agents,or any combination thereof—for example, a sterile liquid, paste or gelor other solid excipients or carriers and optionally one or more otheringredients—to provide a sterile S-nitrosothiol-containingpharmaceutical composition for therapeutic or prophylactic use. Thepresent invention also provides in a further aspect anS-nitrosothiol-containing pharmaceutical composition so formed orformable.

The final S-nitrosothiol-containing pharmaceutical composition fortherapeutic or prophylactic use may be for use in a method of human orveterinary therapy or prophylaxis. The method of therapy or prophylaxismay, for example, involve inducing arterial or venous smooth musclerelaxation, reducing augmentation index, reducing augmentation pressure,reducing arterial stiffness, inhibiting platelet aggregation, inducing Tcell apoptosis and activating guanylate cyclase in a human or animal, ormay be a method of treating or preventing a disease or disorder whichresponds to S-nitrosothiol or NO therapy, for example pre-eclampsia,severe pre-eclampsia, eclampsia, HELLP syndrome, organ transplantationperfusion, organ dialysis, post-operative conditions of balloonangioplasty, acute myocardial infarction, unstable angina, cerebralembolism, hypertension, atherosclerosis, restenosis, ischemia and heartfailure, other cardiovascular proliferative, inflammatory, contractileand hypertensive disorders, and pre-conditioning related disorders ofthe heart and brain, esophageal spasm, biliary spasm, colic and othermotility and smooth muscle disorders of the gastrointestinal tract,erectile dysfunction, stroke, bronchial constriction, cystic fibrosis,pneumonia, asthma, pulmonary fibrosis, and other pulmonary disordersinvolving diminished gas exchange or inflammation, as well as infectiousdiseases of viral, bacterial and other origin, disorders of red bloodcells characterised by S-nitrosothiol deficiency, abnormal rheology orimpaired vasodilation (such as sickle cell disease and storedblood-related diathesis), and thrombotic disorders.

The ionising radiation may be selected from electron beam radiation,gamma radiation and X-rays.

Electron beam (e-beam) radiation is characterised by low penetration andhigh dosage rates and requires the shortest exposure times in order toirradiate the S-nitrosothiol; the time of exposure to the sterilisingdose of ionising radiation in the case of e-beam radiation may, forexample, be less than about 1 hour; for example less than about 45minutes; for example less than about 30 minutes; for example less thanabout 15 minutes; for example less than about 2 minutes; for exampleless than about 1 minute; for example less than about 45 seconds; forexample less than about 30 seconds.

Gamma radiation is characterised by high penetration and low dosagerates and provides homogenous irradiation that requires longer exposuretime; the time of exposure to the sterilising dose of ionising radiationin the case of gamma radiation may, for example, be less than about 24hours; for example less than about 18 hours; for example less than about12 hours; for example less than about 10 hours; for example less thanabout 6 hours; for example less than about 3 hours; for example lessthan about 2 hours; for example about 1 hour; and typically at leastabout 1 hour.

The temperature of the S-nitrosothiol or S-nitrosothiol-containingmaterial during the exposure to the ionising radiation is preferably inthe range of about −100° C. to about +40° C. A temperature in the rangeof about −80° C. to about +35° C. is particularly suitable. Thetemperature may be allowed to fluctuate during the irradiation, subjectto not exceeding about (+)40° C., which can be ensured by performing theirradiation in a temperature-controlled container. However, we havefound that very good results are achieved by positive cooling of theS-nitrosothiol to restrict elevation of temperature during irradiation,for example to a temperature in the range of about −80° C. to about +35°C., for example from about −80° C. to about +30 ° C., for example notgreater than about 30° C., for example not greater than about 28° C.,for example not greater than about 20° C., for example not greater thanabout 15° C., for example not greater than about 10° C., for example notgreater than about 0° C., for example not greater than about −30° C.,for example not greater than about −60° C., for example not greater thanabout −70° C., during the sterilising exposure to the ionisingradiation.

The method of preparing the sterile dry solid S-nitrosothiol or asterile dry solid pharmaceutical pre-composition comprisingS-nitrosothiol according to the second aspect of the present inventionmay suitably be performed using electron beam radiation at an absorbeddose of up to about 50 kGy, for example at about 5 kGy (e.g. about 3 toabout 7 kGy), or at about 15 kGy (e.g. about 13 to about 17 kGy), or atabout 25 kGy (e.g. about 23 to about 27 kGy), or at about 35 kGy (e.g.about 33 to about 37 kGy), or at about 50 kGy (e.g. about 47 to about 53kGy), the temperature of the material to be sterilised starting at roomtemperature conditions (about 18 to about 24° C.) but with freedom tofluctuate higher, and the exposure to the e-beam radiation taking placeover up to about be less than about 1 hour; for example up to about 45minutes; for example up to about 30 minutes; for example up to about 15minutes; for example up to about 2 minutes; for example up to about 1minute; for example up to about 45 seconds; for example up to about 30seconds. The maximum temperature of the material to be sterilised maysuitably be controlled to not greater than about 40° C., for example notgreater than about 35° C., for example not greater than about 30° C.,for example not greater than about 28° C., for example not greater thanabout 20° C.

In another embodiment, the method of preparing the sterile dry solidS-nitrosothiol or a sterile dry solid pharmaceutical pre-compositioncomprising S-nitrosothiol according to the second aspect of the presentinvention may suitably be performed using electron beam radiation at anabsorbed dose of up to about 50 kGy, for example at about 5 kGy (e.g.about 3 to about 7 kGy), or at about 15 kGy (e.g. about 13 to about 17kGy), or at about 25 kGy (e.g. about 23 to about 27 kGy), or at about 35kGy (e.g. about 33 to about 37 kGy), or at about 50 kGy (e.g. about 47to about 53 kGy), the temperature of the material to be sterilised beingmaintained at a temperature below about 35° C., for example below about30° C., for example below about 28° C., for example below about 20° C.,for example below about 15° C., for example below about 5° C., forexample below about 0° C., for example below about −30° C., for examplebelow about −60° C., for example below about −70° C., for example atabout −80° C., and the exposure to the radiation taking place over up toabout 1 hour, for example up to about 45 minutes, for example up toabout 30 minutes, for example up to about 15 minutes, for example up toabout 2 minutes, for example up to about 1 minute, for example up toabout 45 seconds, for example up to about 30 seconds.

In another embodiment, the method of preparing the sterile dry solidS-nitrosothiol or a sterile dry solid pharmaceutical pre-compositioncomprising S-nitrosothiol according to the second aspect of the presentinvention may suitably be performed using gamma radiation at an absorbeddose of up to about 50 kGy, for example at about 5 kGy (e.g. about 3 toabout 7 kGy), or at about 15 kGy (e.g. about 13 to about 17 kGy), or atabout 25 kGy (e.g. about 23 to about 27 kGy), or at about 35 kGy (e.g.about 33 to about 37 kGy), or at about 50 kGy (e.g. about 47 to about 53kGy), the temperature of the material to be sterilised being maintainedat a temperature below about 35° C., for example below about 30° C., forexample below about 30° C., for example below about 28° C., for examplebelow about 20° C., for example below about 15° C., for example belowabout 5° C., for example below about 0° C., for example below about −30°C., for example below about −60° C., for example below about −70° C.,for example at about −80° C., and the exposure to the radiation takingplace over up to about 24 hours; for example up to about 18 hours; forexample up to about 12 hours; for example up to about 10 hours; forexample up to about 6 hours; for example up to about 3 hours; forexample up to about 2 hours; for example about 1 hour; and typically atleast about 1 hour.

We have found that sterilisation using gamma radiation, with thematerial to be sterilised starting at room temperature conditions (about18 to about 24° C.) but with freedom to fluctuate higher, could requirean exposure to the radiation for more than about 1 hour, for examplefrom about 1 to about 24 hours; for example up to about 18 hours; forexample up to about 12 hours; for example up to about 10 hours; forexample up to about 6 hours; for example up to about 3 hours; forexample up to about 2 hours. In addition, such long exposure to gammaradiation without temperature control has the undesirable consequencethat the temperature can rise above about 40° C., for example to about60° C., and the purity of the S-nitrosothiol can consequently bereduced, for example by about 4 to about 10% relative to anon-irradiated matching control.

Surprisingly, the method of second aspect of the present inventionsterilises the S-nitrosothiol, for example S-nitrosoglutathione, withoutreduction of the purity by more than about 5.0% through degradation.Because the degradation of S-nitrosothiols proceeds via homolyticfission of the S—NO bond to release NO at high quantum yields (0.2 to0.8), and is induced by relatively low energy electromagnetic radiationsuch as UV light or sunlight (Manoj et al., 2009) it would have beenexpected that degradation would have been significant under exposure toionising radiation. Maintenance of a low temperature (positive cooling)alongside short irradiation time intervals and light protective storagecontainers has, however, been found to suppress the tendency for themolecules to degrade, preserving high purity for pharmaceutical use.

The expressions “sterile”, “sterilise” and related expressions usedherein refer to a level of sterility (absence of microorganisms) whichsatisfies the requirements of the European Medicines Agency (EMA) forsterility of pharmaceutical and veterinary products. The sterilityassurance level (SAL) refers to the probability of a single unit (forexample, the interior surface and all contents of a vial, ampoule, bagor other container containing solid S-nitrosothiol-containing materialand a gas-filled space above) being non-sterile after it has beensubjected to sterilisation. In the present invention, a unit “issterile” or “has been sterilised” if the SAL is less 10⁻⁶ or lower, i.e.that one in a million of those units or fewer would be non-sterile.

DETAILED DESCRIPTION OF THE INVENTION S-nitrosothiols

S-nitrosothiols used in the present invention may, for example, beselected from the following or any combination of one or more thereof:

-   -   S-nitrosoglutathione (GSNO)    -   S-nitroso-L-cysteine (CySNO)    -   S-nitroso-N-acetyl-cysteine (SNAC)    -   S-nitroso-L-cysteinemethyl-ester (CMESNO)    -   S-nitroso-D,L-penicillamine (PSNO)    -   S-nitroso-N-acetyl-D,L-penicillamine (SNAP)    -   S-nitroso-N-acetylcysteamine (ACSNO)    -   S-nitroso-beta-mercaptosuccinic acid    -   1-S-nitrosothio-beta-D-galactopyranose    -   S-nitrosothioglycerol    -   S-nitrosohomocysteine    -   S-nitrosocysteinylglycine    -   S-nitrosocaptopril    -   alkyl, cycloalkyl or aryl thionitrites, such as, for example,        methyl thionitrite, ethyl thionitrite, n-propyl thionitrite,        s-propyl thionitrite, n-butyl thionitrite, s-butyl thionitrite,        tert-butyl thionitrite, n-pentyl thionitrite, n-hexyl        thionitrite, cyclohexyl thionitrite, phenyl thionitrite    -   S-nitroso derivatives of cysteine-containing proteins, oligo-        and poly-peptides, for example S-nitrosoalbumin,        poly-S-nitrosoalbumin or S-nitrosohemoglobin

and any derivative thereof

and a salt of any of the foregoing.

A preferred S-nitrosothiol used in the present invention isS-nitrosoglutathione (GSNO) or a derivative or salt thereof. A synthesisof S-nitrosoglutathione and S-nitroso-L-cysteine from respectivelyglutathione and L-cysteine is described by Hart (1985).

The expression “derivative” used herein to refer to S-nitrosothiols,particularly means a compound which retains the characteristic —S—N═Omoiety but differs from the named S-nitrosothiol in one or more of thefollowing respects, and preferably only in that or those respects:

-   -   a hydrocarbyl moiety is substituted by one or more of the        following substituents: one or more halogen atom; one or more        hydroxyl group; one or more C₁₋₈ alkyl group; one or more C₂₋₈        alkenyl group; one or more C₂₋₈ alkynyl group; one or more C₁₋₈        alkoxy group; one or more enol ether group —C═C(OR) wherein        preferably R is selected from hydrogen, alkyl, alkenyl, alkynyl,        aryl, heteroaryl, aralkyl, heteroalkyl, cycloalkyl and        heterocyclyl; one or more enol ester group —C═C(OC(O)R) wherein        preferably R is selected from hydrogen, alkyl, alkenyl, alkynyl,        aryl, heteroryl, aralkyl, heteroalkyl, cycloalkyl and        heterocyclyl; one or more carboxylate group; one or more        esterified carboxylate group;    -   a hydroxyl moiety is esterified;    -   a compound is prepared as a hydrate, solvate or metal chelate,        or any prodrug form.

In the foregoing paragraph, the expression “esterified” includes withoutlimitation the esters selected from alkyl, alkenyl, alkynyl, aryl,heteroaryl, aralkyl, heteroalkyl, cycloalkyl and heterocyclyl esters ofacidic groups such as, for example, carboxylic acids, phosphoric acids,phosphinic acids, sulfonic acids, sulfinic acids and boronic acids.

Salt forms of S-nitrosothiols include compounds which differ from thenamed S-nitrosothiol in that any acid group or moiety of theS-nitrosothiol is present in the form of a salt formed with a suitablebase and/or any basic group or moiety of the S-nitrosothiol is presentin the form of a salt formed with a suitable acid. Bases that may beused to form salts with S-nitrosothiols containing suitable acid groupsinclude, for example, bases such as sodium hydroxide, potassiumhydroxide, lithium hydroxide, barium hydroxide, calcium hydroxide,magnesium hydroxide, transition metal hydroxides such as zinc hydroxide,ammonia, organic amine bases (such as, for example,N,N′-dibenzylethylenediamine, chloroprocaine, choline,hydroxyalkylamines such as diethanolamine, ethylenediamine,N-methylglucamine, procaine, N-benzylphenethylamine,1-p-chlorobenyl-2-pyrrolidin-1′-yl-methylbenzimidazole, alkylamines suchas diethylamine, piperazine and tris(hydroxymethyl)aminomethane), sodiumcarbonate and sodium bicarbonate. Acids that may be used to form saltswith S-nitrosothiols containing suitable basic groups include, forexample, acids such as hydrochloric acid, hydrobromic acid, sulphuricacid, nitric acid, phosphoric acid, acetic acid, citric acid, lacticacid, maleic acid, ascorbic acid, succinic acid, butyric acid, valericacid, fumaric acid, tartaric acid and propionic acid.

The above compounds are known or may readily be prepared from availablesources by standard chemical synthetic methods well known in the art.For pharmaceutical use the compounds may be administered to animals andhumans in suitable dosages without toxic effects and are eitherpharmaceutically active or are prodrugs of pharmaceutically activecompounds.

Purity Levels and Measurement, Impurities

The S-nitrosothiol used in the present invention may contain a limitedamount of impurities. It is preferred that the S-nitrosothiol, forexample S-nitrosoglutathione, has a purity greater than or equal toabout 95.0% as determined by known methods in the art, for example highperformance liquid chromatography (HPLC) or direct UV adsorption (A210-335 nm).

In one embodiment, the S-nitrosothiol used in the present invention, forexample S-nitrosoglutathione, has a purity ranging from about 95.0% toabout 100.0% or any value within that range, for example at least about97.0%, or at least about 98.0%, or at least about 99.0%.

The sterilisation method according to the present invention preferablysterilises the S-nitrosothiol without reduction of the purity by morethan about 5.0% through degradation. Degradation, if it occurs, isdetectable by an increase in the products of one or more of unimolecularhomolytic scission of the S-nitrosothiol at the S—N bond, enzymaticdegradation, reductive degradation and oxidative degradation(decomposition). Such detection of degradation products may be performedby known methods in the art, for example high performance liquidchromatography (HPLC) or direct UV adsorption (A 210-335 nm).

Impurities present in the S-nitrosothiol can typically include thecorresponding denitrosated compound with or without oxidation orreduction. The principal impurities arising in any particularS-nitrosothiol can be readily ascertained by chemical analysis. Forexample common impurities of S-nitrosoglutathione include glutathione(GSH) and glutathione disulfide (GSSG). In an embodiment, the compoundsand formulations used in the present invention contain total impurities(including reduced and oxidised L-glutathione) in a range of from about0.0% to about 5.0% or any specific value within that range, for exampleless than about 3.0% or less than about 2.5% or less than about 2.0%.

Sterility Levels and Measurement

The dose of radiation to sterilise the S-nitrosothiol can be determinedby methods well known in the art. ISO 11137-2:2013 specifies methods fordetermining the minimum dose needed to achieve a specified requirementfor sterility and methods to substantiate the use of 25 kGy or 15 kGy asthe sterilisation dose to achieve a sterility assurance level, SAL, of10⁻⁶. ISO 11137-2:2013 also specifies methods of sterilisation doseaudit used to demonstrate the continued effectiveness of thesterilisation dose. The EMA, the European Pharmacopoeia and the USPharmacopeia typically expect a radiation dose of >25 kGy as thereference sterilisation dose to achieve a sterility assurance level(SAL) of 10⁻⁶.

A suitable radiation dose for the present invention is 15-35 kGy.However, this sterilisation dose can be varied according to the ISO11137-2:2013 guideline (for example, 5-50 kGy could be used if suitablyjustified).

The radiation dose used in the present invention should be such as toachieve a Sterility Assurance Level (SAL) of 10⁻⁶, namely a probabilityof one in a million that a single sterilised vial of pharmaceuticalmaterial is non-sterile after treatment.

Ionising Radiation and Sources

Sterilisation by irradiation involves a compromise between inactivationof the contaminating microorganisms and damage to the product beingsterilised.

Gamma radiation is characterised by its deep penetration and low dosagerates. The energy of gamma radiation, as electromagnetic quantum waves,is similar to light, but with higher photon energy and shorterwavelength. The interaction between high-energy gamma radiation andmatter forms ion pairs by ejecting electrons, leading to free-radicalformation and excitation. The free radicals are extremely reactivebecause each has an unpaired electron on one of its outer orbitals.Free-radical reactions may involve gas liberation, double-bond formationand scission, exchange reactions, electron migration, and cross-linking.In fact, any chemical bond may be broken and any potential chemicalreaction may take place. In crystalline materials, this may result invacancies, interstitial atoms, collisions, thermal spurs, and ionisingeffects.

Gamma irradiators are powered by Cobalt-60, effectively killingmicroorganisms throughout the product and its packaging. The amount ofradiation received depends on the type of product and its doserequirements.

E-Beam radiation is a form of ionising energy that is characterised byits low penetration and high dosage rates. The “beam” (a concentrated,highly charged stream of electrons) is generated by accelerators capableof producing continuous or pulsed beams. As the product being sterilisedpasses beneath or in front of the e-beam, energy from the electrons isabsorbed, altering various chemical and biological bonds and destroyingthe DNA and reproductive capabilities of microorganisms.

X-ray radiation is a further form of ionising electromagnetic radiation.Whereas gamma radiation originates in the nucleus, X-rays originate inthe electron fields surrounding the nucleus or are machine-produced.

Apparatus and facilities for providing ionising radiation forsterilisation of chemicals, for example gamma radiation, e-beamradiation or X-ray radiation, are well known and commercially available.

The radiation dosage applied in the method according to the presentinvention is preferably monitored using a dosimeter. Dosimeters arecommercially available and will be known to those skilled in the art.Dosimetrically monitored application of radiation allows products to beprocessed, verified and immediately released for shipment.

In the method of the present invention it is preferred that the ionisingradiation is applied so as to give a reproducible sterilisation dose.Gamma radiation is well suited to irradiating a large batch over a fewhours cycle. E-beam is a continuous process that can deliver a requireddose in a few seconds as individual boxes pass by the e-beamaccelerator.

We have found particularly in the present invention that certaincontrolled conditions for gamma and e-beam irradiations result in asurprisingly low degree of product degradation, enabling the purity ofthe initial chemical to be effectively maintained through to the sterileproduct for medical or other physiological use.

Apparatus and Method for Performing the Invention

The sterilising method of the present invention is suitably performed inan apparatus comprising:

-   -   a support system for supporting the material to be sterilised in        an appropriate container;    -   an ionising radiation source adapted to irradiate a radiation        field;    -   a drive system adapted to cause relative movement of the        container holding the material within the radiation field, to        permit even distribution of the radiation;    -   a dosimeter system to measure the radiation dose absorbed by the        material in the container;    -   a temperature control system to provide a desired temperature        around the container holding the material; and    -   means to terminate the application of the radiation to the        container when the required sterilising dosage is achieved.

Apparatus of this general type are commercially available and do notrequire detailed description.

Temperature Control

It is well known to those skilled in the art that irradiation canelevate the temperature of the irradiated material. The temperature ofthe S-nitrosothiol-containing material during the exposure to theionising radiation is preferably maintained in the range of about −100°C. to not greater than +40° C. A temperature in the range of about −80°C. to about +35° C. is particularly suitable. The temperature may beallowed to fluctuate during the irradiation, preferably subject to notexceeding about (+)40° C., which can be ensured by performing theirradiation in a temperature-controlled container. However, we havefound that very good results are achieved by maintaining the temperatureduring irradiation within a defined range by positive temperaturecontrol or cooling of the S-nitrosothiol-containing material, forexample to a temperature in the range of about −80° C. to about +35° C.,for example not greater than about 30° C., not greater than about 28°C., not greater than about 20° C., not greater than about 15° C., notgreater than about 10° C., not greater than about 5° C., not greaterthan about 0° C., for example not greater than about −30° C., forexample not greater than about −60° C., for example not greater thanabout −70° C., during the sterilising exposure to the ionisingradiation.

For commercial use, for example on a large batch scale or in acontinuous production process, conventional thermostatically controlledcontainers with appropriate refrigeration or cryoengineering systems maybe used in the performance of the present invention, to achieve andmaintain the desired temperature conditions for the irradiation.

On a small batch scale, dry ice (solid CO₂) at −80° C., water ice at 0°C., or other cold materials at known temperatures, are effective toestablish and maintain a desired temperature in the range of about +40°C. to about −80° C. for irradiation, as will be illustrated by way ofnon-limiting example in Example 2 below.

Pharmaceutical Compositions and Formulations

The sterile dry solid S-nitrosothiol or the sterile pharmaceuticalpre-composition used in the present invention is preferably formulatedso that, on mixing with a suitable sterile diluent, excipient and/orcarrier, for example a liquid, paste or gel or other solid excipients orcarriers, to dissolve or disperse the dry solid material without loss ofsterility, and optionally mixing with one or more additionalingredients, a sterile pharmaceutical formulation is thus formed whichis compatible with the intended treatment or prophylaxis and theintended route of administration. Examples of routes of administrationinclude parenteral (for example, intravenous), intradermal,subcutaneous, inhalation, transdermal (topical), transmucosal (gingivalor buccal), vaginal and rectal administration routes.

The total of (a) the dry solid material according to the first aspect ofthe present invention and (b) the sterile liquid and any optionaladditional ingredient(s), a sterile S-nitrosothiol-containingpharmaceutical composition is prepared from the sterilisedS-nitrosothiol or pre-pharmaceutical composition according to the firstaspect of the present invention. It is preferred that the sterileS-nitrosothiol-containing pharmaceutical composition will be prepared inthis way shortly before administration to a human or animal patient.

The required ingredients for the total final composition, as well astheir distribution between the dry solid material according to the firstaspect of the present invention, the sterile liquid to be mixedtherewith and any optional additional ingredient(s) to be mixed witheither or both of the foregoing during the method of making-up the finalpharmaceutical composition, will be well known to those skilled in theart or readily decided on a case by case basis by those skilled in theart following normal formulation practice. For example, as is wellknown, final ready-to-use solutions or suspensions can include one ormore of the following components: a sterile diluent such as water forinjection, saline solution, fixed oils, polyethylene glycols, glycerin,propylene glycol or other synthetic solvents; antibacterial agents suchas benzyl alcohol or methyl parabens; antioxidants such as ascorbic acidor sodium bisulfite; chelating agents such as ethylenediaminetetraaceticacid; buffers such as acetates, citrates or phosphates; and agents forthe adjustment of tonicity such as sodium chloride or dextrose.

A sterile pre-composition of the present invention, or a non-sterilepre-composition prepared to be sterilised in accordance with the presentinvention, or a sterile composition after being made up foradministration using a sterile S-nitrosothiol or sterile pre-compositionaccording to the present invention, will thus comprise at least oneS-nitrosothiol in combination with at least one pharmaceuticallyacceptable diluent, excipient, carrier, additional active agent, or anycombination thereof. As used herein, “pharmaceutically acceptableexcipient” or “pharmaceutically acceptable carrier” is intended toinclude any and all solvents, dispersion media, coatings, antibacterialand antifungal agents, isotonic and absorption delaying agents, and thelike, compatible with pharmaceutical administration. Suitable diluents,excipients and carriers are described in Remington: The Science andPractice of Pharmacy, 22^(nd) Edition, 2012, Pharmaceutical Press, whichis incorporated herein by reference. Examples of such diluents,excipients and carriers include, but are not limited to, water, saline,Ringer's solutions, dextrose solution, and 5% human serum albumin.Liposomes and non-aqueous vehicles such as fixed oils may also be used.Pharmaceutically acceptable carriers can also include solid carrierssuch as lactose, terra alba, sucrose, talc, gelatin, agar, pectin,acacia, magnesium stearate, stearic acid and the like. Exemplary liquidcarriers include syrup, peanut oil, olive oil, water and the like.

An excipient or carrier may include time-delay material known in theart, such as glyceryl monostearate or glyceryl distearate, alone or witha wax, ethylcellulose, hydroxypropylmethylcellulose, methylmethacrylateor the like. Other fillers, diluents, flavorants, and other additivessuch as are known in the art may also be included in a sterilepre-composition of the present invention, or a non-sterilepre-composition prepared to be sterilised in accordance with the presentinvention, or a sterile composition after being made up foradministration using a sterile S-nitrosothiol or sterile pre-compositionaccording to the present invention. The use of such media and agents forpharmaceutically active substances is well known in the art. Exceptinsofar as any conventional media or agent is incompatible with theactive compound, use thereof in the compositions is contemplated. Morethan one S-nitrosothiol can be present in the compositions andpre-compositions, according to clinical need of the patient. One or moresupplementary physiologically active compounds, of a class other thanthe S-nitrosothiols, can also be incorporated into the compositions andpre-compositions.

The made up pharmaceutical compositions suitable for parenteral usetypically include suitable carriers selected from physiological saline,bacteriostatic water, Cremophor EL (BASF, Parsippany, N.J.) andphosphate buffered saline (PBS). In all cases, the composition asadministered must be sterile and should be fluid to the extent that easysyringability exists. A carrier can be a solvent or dispersion mediumcontaining, for example, water, ethanol, polyol (for example, glycerol,propylene glycol, and liquid polyethylene glycol, and the like), andsuitable mixtures thereof. The proper fluidity can be maintained, forexample, by the use of a coating such as lecithin, by the maintenance ofthe required particle size in the case of dispersion and by the use ofsurfactants. Prevention of the action of microorganisms can be achievedby various antibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In manycases, it will be preferable to include isotonic agents, for example,sugars, polyalcohols such as manitol, sorbitol, sodium chloride in thecomposition. Prolonged absorption of the injectable compositions can bebrought about by including in the composition an agent which delaysabsorption, for example, aluminium monostearate and gelatin.

For administration by inhalation, the made up compositions can becapable of being delivered in the form of a fine particulate powder oran aerosol spray from pressured container or dispenser that contains asuitable propellant, e.g., a gas such as carbon dioxide, or a nebulizer.

For transmucosal or transdermal administration, penetrants appropriateto the barrier to be permeated are suitably included in the made upcompositions. Such penetrants are generally known in the art, andinclude, for example, for transmucosal administration, detergents, bilesalts, and fusidic acid derivatives. Transmucosal administration can beaccomplished through the use of nasal sprays or suppositories. Fortransdermal administration, the S-nitrosothiol(s) and any other activeingredient(s) are suitably formulated into ointments, salves, gels, orcreams as generally known in the art.

The final compositions can be prepared in the form of suppositories(e.g., with conventional suppository bases such as cocoa butter andother glycerides) or retention enemas for rectal delivery.

The final compositions may comprise a stabilizing buffer and can furthercomprise a surfactant. The buffer and/or surfactant or ingredientsthereof may if desired be present in the sterile pre-composition of thepresent invention or a non-sterile pre-composition prepared to besterilised in accordance with the present invention, or may be addedwhen making up the sterile final composition for administration from asterile S-nitrosothiol or sterile pre-composition according to thepresent invention. The amount of surfactant that can be present canrange from about 0.1% w/w to about 10% w/w with respect to theS-nitrosothiol. In an embodiment, the amount of surfactant present is atleast 1% w/w with respect to the S-nitrosothiol. In an embodiment, theamount of surfactant present is up to about 5% w/w with respect to theS-nitrosothiol. Examples of suitable surfactants include, but are notlimited to, fatty acid, fatty acid esters including fatty acidtrigylcerides, fatty alcohols, salts of fatty acids, oleyl alcohol,sorbitan mono-oleate, sorbitan monolaurate, polyoxyethylene (20)sorbitan monolaurate, polyoxyethylene (20) sorbitan mono-oleate, naturallecithin, oleyl polyoxyethylene (2) ether, stearyl polyoxyethylene (2)ether, lauryl polyoxyethylene (4) ether, block copolymers of oxyethyleneand oxypropylene, oleic acid, salts of oleic acid, synthetic lecithin,diethylene glycol dioleate, tetrahydrofurfuryl oleate, ethyl oleate,isopropyl myristate, isopropyl palmitate, glyceryl mono-oleate, glycerylmonostearate, glyceryl monoricinoleate, cetyl alcohol, stearyl alcohol,cetyl pyridinium chloride, olive oil, glyceryl monolaurate, corn oil,cotton seed oil, sunflower seed oil, polyoxyethylenesorbitan monooleate,sorbitan trioleate, oligolactic acid, lecithin, (poly)alkoxy derivativesincluding polyalkoxy alcohols, in particular 2-(2-ethoxyethoxy) ethanol.Additional (poly)alkoxy derivatives include polyoxyalkyl ethers andesters, such as polyoxyethylene ethers and esters, including, but notlimited to, polyoxyethylene alkyl ethers, polyoxyethylene sorbitan fattyacid esters and polyoxyethylene stearates.

The final compositions may optionally comprise additional ingredients inknown manner, such as additives that serve as preservatives,antioxidants, radical quenchers, pharmaceutically active agents,adjuvants, carriers, chemical stabilizers, and/or polymers. Suchoptional additional ingredients or some of them may if desired bepresent in the sterile pre-composition of the present invention or anon-sterile pre-composition prepared to be sterilised in accordance withthe present invention, or may be added when making up the sterile finalcomposition for administration from a sterile S-nitrosothiol or sterilepre-composition according to the present invention. The amount ofadditional ingredients included in a final made up formulation of anS-nitrosothiol can be, for example, 0% to about 1% w/w.

It is especially advantageous to formulate final ready to usecompositions in dosage unit form for ease of administration anduniformity of dosage. “Dosage unit form” as used herein refers tophysically discrete units suited as unitary dosages for the subject tobe treated, each unit containing a predetermined quantity of activeagent calculated to produce the desired therapeutic effect, inassociation with the required one or more pharmaceutical carriers,excipients, diluents, additional active agents, or any combinationthereof. As is well known to those skilled in the art, thespecifications for dosage unit forms are dictated by and directlydependent on the unique characteristics of the active S-nitrosothiolagent and the particular therapeutic effect to be achieved, and thelimitations inherent in the art of compounding such an active agent forthe treatment of individuals.

The dry solid material of the present invention—that is, the sterile drysolid S-nitrosothiol, for example S-nitrosoglutathione, or the steriledry solid pre-composition containing S-nitrosothiol, for exampleS-nitrosoglutathione—can be present in a measured weight so that, aftermaking up into the final sterile pharmaceutical composition foradministration, the final composition for administration contains a unitdose of the S-nitrosothiol active agent or a multiple of the said unitdose such that portions of the final composition can be administeredsequentially before a new composition needs to be made up from dry solidmaterial.

For this purpose, the measured weight of the dry solid material—that is,the sterile dry solid S-nitrosothiol, for example S-nitrosoglutathione,or the sterile dry solid pre-composition containing S-nitrosothiol, forexample S-nitrosoglutathione—is enclosed in single dose or multiple dosecontainers such as single dose or multiple dose vials, single doseampoules, single dose or multiple dose bags or disposable single dosesyringes which containers can in each case, for example, in each case bemade of glass or plastic or a combination thereof. As previouslymentioned, because S-nitrosothiols (for example, S-nitrosoglutathione)are light sensitive, the components of the dose containers have suitableoverwraps or are protected from light, for example being tinted oropaque. All handling equipment and containers for the pharmaceuticalcompositions, or any intermediate formulations in the route to preparethe pharmaceutical compositions such as sterile liquids, containing theS-nitrosothiol made up from the sterile dry solid material according tothe present invention should similarly be tinted or opaque or providedwith suitable overwraps to protect them from light. Such handlingequipment and containers may, for example, include infusion lines andsyringes.

Solid Forms

The dry solid S-nitrosothiol (for example, S-nitrosoglutathione) or thedry solid pre-composition containing S-nitrosothiol (for exampleS-nitrosoglutathione) may suitably be processed in conventional mannerprior to sterilisation, to produce particles in a desired size range.For example, the dry solid material can be milled or micronised usingsuitable equipment for example an air jet mill, hammer mill, ball millor microniser.

Alternatively, particles in the desired particle range may be obtainedby, for example, lyophilisation, spray drying or controlledcrystallization methods, for example, crystallization usingsupercritical fluids.

The dry solid S-nitrosothiol (for example, S-nitrosoglutathione)particles or the dry solid pre-composition containing S-nitrosothiol(for example S-nitrosoglutathione) particles may, for example, have aweight average particle diameter in the range of about 0.1 μm to about50 μm, for example about 0.2 μm to about 20 μm, or about 1 μm to about15 μm.

Containers

The containers for the dry solid S-nitrosothiol (for example,S-nitrosoglutathione) or the dry solid pre-composition containingS-nitrosothiol (for example S-nitrosoglutathione), for example as drysolid particles, are preferably oxygen-impermeable andmoisture-impermeable. The containers have convenient sizes, particularlyunit dosage sizes or sizes in multiples of a unit dose. Those skilled inthe art can readily determine appropriate container sizes and the weightof the dry solid S-nitrosothiol (for example, S-nitrosoglutathione) orthe dry solid pre-composition containing S-nitrosothiol (for exampleS-nitrosoglutathione), depending on the intended use and mode ofadministration. As previously described, it is preferred that the drysolid S-nitrosothiol (for example, S-nitrosoglutathione) or the drysolid pre-composition containing S-nitrosothiol (for exampleS-nitrosoglutathione) is placed in the container, the container issealed, and the contents of the container and the inner walls of thecontainer are then sterilised according to the present invention. Thecontainer then holds the sterile dry solid S-nitrosothiol (for example,S-nitrosoglutathione) or the sterile dry solid pre-compositioncontaining S-nitrosothiol (for example S-nitrosoglutathione) for storageand transportation until such time as the final pharmaceuticalcomposition is desired to be made up.

The dry solid material can be placed in the containers prior tosterilisation by filling methods known to those skilled in the art. Suchcontainers can be vials, tubes, syringes, ampoules and the like, e.g.for holding powdered formulations, and may be made of any inertmaterial, such as plastics, polymers, glass and the like.

As previously mentioned, because S-nitrosothiols (for example,S-nitrosoglutathione) are light sensitive, they can be stored insuitable overwraps or containers that are impermeable to oxygen andlight, for example tinted containers (e.g. amber tinted) or aluminiumpouches. Those skilled in the art can readily determine suitablecontainers, overwraps and the like for storing an S-nitrosothiol andother components useful for maintaining the stability of theS-nitrosothiol. Prior to sealing, the storage system may be treated withat least one inert gas, for example, nitrogen, argon, helium, neon,krypton and xenon, to reduce the oxygen content within the system. Thesealed storage system (e.g. amber vials and other light protectivestorage containers) with the measured dose of S-nitrosothiol may then besubjected to the sterilising treatment in accordance with the presentinvention. The storage system assists to stabilise the solidformulations and to retain the purity level of the S-nitrosothiol overan extended period of time and normal ambient temperatures.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be described in more detail below, butwithout limitation, by reference to the accompanying drawings, in which:

FIG. 1 shows the effects of the (a) e-beam and (b) gamma sterilisationtreatment at 35 kGy dose and 15 kGy dose of Example 1 on the purity ofthe S-nitrosoglutathione (GSNO; % decrease in purity compared withnon-irradiated control sample). The temperature reached approximatelyequal to (˜) 27.5° C. for e-beam and less than or equal to (<) 60° C. or40° C. for gamma radiation;

FIG. 2 shows the effects of the (a) e-beam and (b) gamma sterilisationtreatment at 35 kGy dose and 15 kGy dose of Example 2 on the purity ofthe S-nitrosoglutathione (GSNO; % decrease in purity compared withnon-irradiated control sample). The temperature was less than (<) 27.5°C. or was held at −80° C. for 35 kGy and 15 kGy for e-beam radiation.The temperature reached less than or equal to (<) 32.5° C. or was heldat −80° C. for 35 kGy or less than or equal to (<) 27.5° C. or was heldat −80° C. for 15 kGy for gamma radiation.

FIG. 3 is a composite of FIGS. 1 and 2 and shows the effects of the (a)e-beam and (b) gamma sterilisation treatments of Examples 1 and 2 on thepurity of the S-nitrosoglutathione (GSNO; % decrease in purity comparedwith non-irradiated control sample) at various temperatures;

FIG. 4 is a schematic representation of the apparatus for e-beamirradiating vials containing S-nitrosoglutathione (GSNO) in Example 2,the arrows marked “e” show the direction of the e-beam radiation;

FIG. 5 is a schematic representation of the apparatus for gammairradiating vials containing S-nitrosoglutathione (GSNO) in Example 2.The arrows marked “γ” show the direction of the gamma radiation.

EXAMPLES

The following non-limiting examples are provided for furtherillustration of the present invention.

Example 1 Sterilisation of S-nitrosoglutathione Using E-beam and GammaRadiation at Unconstrained Temperature Settings

S-nitrosoglutathione granule samples from a single manufacturing batch,contained in glass vials (up to 250 mg/vial), were stored beforesterilisation surrounded by dry ice (solid CO₂) at about −80° C. Thematching controls were not irradiated but underwent similar conditionsof storage and thermal management before, during and after irradiation,as compared with the S-nitrosoglutathione vials that were irradiated.The control purity levels of the S-nitrosoglutathione, and the level ofspecific impurities glutathione (GSH) and oxidised glutathione (GSSG)content and total impurities content, were analysed. Vials were exposedto either electron beam (e-beam) irradiations or to gamma irradiations.The vials were removed from the dry ice container and sterilised via tworadiation dose conditions (15 kGy and 35 kGy) described below underhigher temperature conditions (with surrounding air temperature in therange about 18 to 24° C. and with the temperature of the vials free tofluctuate to higher temperature). After irradiation, the vials wereimmediately surrounded by dry ice at about −80° C. and analysed forpost-sterilisation determination of any changes in purity against thecontrol.

The e-beam radiation was performed using a moving carrier system set upfor delivering a 15 kGy dose and a 35 kGy dose. The 15 kGy radiationdose lasted about 10-15 minutes and the temperature reachedapproximately equal to 27.5° C. (designated 27.5° C. in the Tables andFigs.). The 35 kGy radiation dose lasted about 30 minutes and thetemperature reached approximately equal to 27.5° C. (designated ˜27.5°C. in the Tables and the Figs.). The radiation doses were measured byconventional dosimeters.

The gamma radiation was performed using a moving carrier system set upfor delivering a 15 kGy dose and a 35 kGy dose. The 15 kGy doseradiation lasted about 8-10 hours and the temperature reached up to 40°C. The 35 kGy dose radiation lasted about 18-24 hours, with atemperature reaching up to 60° C. The radiation doses received weremeasured by conventional dosimeters.

The results are shown in FIGS. 1 and 3 and Table 1.

TABLE 1 Summary of results for e-beam and gamma radiation (Example 1)e-beam gamma Dose level 35 kGy 15 kGy 35 kGy 15 kGy Time of irradiation~30 10-15 18-24 8-10 minutes minutes hours hours Temperature (° C.)~27.5 ~27.5 <60 <40 during irradiation GSNO purity (decrease −1.37 −0.55−9.45 −4.47 % of control) GSH impurity 0.36 0.17 0.15 0.34 (% unitchange) GSSH impurity 0.32 0.11 6.63 1.25 (% unit change) Totalimpurities 1.26 0.53 9.12 4.25 (% unit changes)

The unconstrained temperature e-beam irradiation of Example 1 at 15 kGyand 35 kGy resulted in a dose dependent decrease in the HPLC purity ofS-nitrosoglutathione. The unconstrained temperature gamma irradiation ofExample 1 at 15 kGy and 35 kGy resulted in a significant decrease in theHPLC purity of S-nitrosoglutathione dependent to temperature, time andradiation dose level. The use of ionising radiation (e-beam and gammaradiation) at unconstrained temperature leads to degradation ofS-nitrosoglutathione as shown by the decrease in purity compared tocontrol. However, the degradation is worse in the case of gammaradiation than in the case of e-beam radiation.

The data show that the level of the specific impurities GSH and GSSG andtotal impurities increased after e-beam and gamma irradiations in atemperature, time and radiation dose level dependent manner.

Example 2

Sterilisation of S-nitrosoglutathione Using E-beam and Gamma Radiationat Constrained Temperatures

The experimental protocol for this Example aims to test in a controlledmanner the effects on purity of a sterilizing irradiation temperature(a) at about −80° C. and (b) under positive cooling (with surroundingair temperature in the range about 18 to 24° C. and with the temperatureof the vials controlled). The same radiation doses as described forExample 1 were applied.

For this Example, S-nitrosoglutathione granule samples, from the samesingle manufacturing batch as in Example 1, contained in amber glassvials (100 mg/vial) were stored before sterilisation at about −80° C.The irradiation process at −80° C. was achieved by the presence of dryice, which was placed to ensure low temperature of the vials but withoutinfluencing the radiation dose delivery characteristics. The matchingcontrols were not irradiated but underwent similar conditions of thermalmanagement before, during and after irradiation, as compared with theS-nitrosoglutathione vials that were irradiated.

The method employed for the e-beam arm of this experiment was asfollows:

The e-beam radiation was performed using a moving carrier system. TheS-nitrosoglutathione vials were stored at −80° C. freezer andtransferred to a dry ice container before irradiation. Before the startof irradiation the S-nitrosoglutathione vials destined for irradiationat ambient temperature (and control vials) were removed from the −80° C.freezer and transferred to a location where the surrounding airtemperature is controlled at 18° C.

Individual low-temperature containers were used for the vials designatedfor each target dose and condition of thermal management. A secondarypackaging box was placed in the lateral centre at the bottom of thefirst low-temperature container, with the vials oriented upright. Theposition of each vial in the configuration was documented. The vialswere always irradiated from the same side. FIG. 4 shows a possiblearrangement of vials in a container for e-beam irradiation. The arrowsmarked “e” show the direction of the radiation. For theS-nitrosoglutathione vials requiring cold chain management, dry ice wasplaced at each lateral short side of the container to ensure a coldchain was maintained during the irradiation process. Each container wasplaced in an irradiation container.

Both the 15 kGy e-beam and 35 kGy radiation doses lasted a few seconds.

Following completion of the desired irradiation process, the irradiatedS-nitrosoglutathione containing vials and correspondent controls werestored at −80° C. in a freezer for subsequent analysis.

The method employed for the gamma arm of this experiment was as follows:

The gamma radiation was performed using gamma radiation emitted fromcobalt-60 radioactive sources. The S-nitrosoglutathione vials werestored at −80° C. in a freezer and transferred to a dry ice containerbefore irradiation. Before the start of irradiation, theS-nitrosoglutathione vials destined for irradiation at ambienttemperature (and control vials) were removed from the −80° C. freezerand transferred to a location where the surrounding temperature wascontrolled at 18° C.

Individual low-temperature containers were used for the samplesdesignated for each target dose and condition of thermal management, asdescribed above in relation to the e-beam arm of this Example.

The secondary packaging was placed in the lateral centre at the bottomof first low-temperature container, with the vials oriented upright.FIG. 5 shows a possible arrangement of vials in a container for gammairradiation. The arrows marked “γ” show the direction of the radiation.For the S-nitrosoglutathione product requiring cold chain management,dry ice was placed at each lateral short side of the low-temperaturecontainer to ensure a cold chain was maintained during the irradiationprocess.

Each low-temperature container was placed in the lateral centre of anirradiation container.

The 15 kGy radiation dose lasted 2 hours and 8 minutes whereas the 35kGy dose lasted about 5 hours and 8 minutes.

When necessary, the dry ice was replenished before execution of thesecond irradiation.

Following completion of the irradiation process, the irradiatedS-nitrosoglutathione products were placed in the designated −80° C.freezer. The control samples were moved from the 18° C. controlledlocation to the designated −80° C. freezer upon completion of the secondirradiation. The time of transfer was recorded.

The results are shown in FIG. 2 and FIG. 3, and Table 2.

TABLE 2 Summary of results for e-beam and gamma radiation (Example 2)e-beam gamma Dose level 35 kGy 15 kGy 35 kGy 15 kGy Time of Few sec. Fewsec. ~5 h ~2 h irradiation Temperature <27.5 −80 <27.5 −80 <32.5 −80<27.5 −80 (° C.) during irradiation GSNO purity −1.12 −0.55 −0.28 −0.16−2.2 −1.01 −0.67 −0.26 (decrease % of control) GSH impurity 0.29 0.230.13 0.10 0.43 0.29 0.17 0.11 (% unit change) GSSH 0.23 0.07 0.13 0.100.36 0.36 0.14 0.11 impurity (% unit change) Total 1.08 0.54 0.27 0.162.11 0.96 0.63 0.25 impurities (% unit changes)

The e-beam irradiations of Example 2 at 15 kGy and 35 kGy resulted in asmall, temperature, time and dose level dependent decrease in the HPLCpurity of S-nitrosoglutathione (GSNO); FIGS. 2 and 3 (labeled (2) forExample 2) and Table 2.

The gamma irradiations of Example 2 at 15 kGy and 35 kGy resulted in asmall, temperature, time and dose level dependent decrease in the HPLCpurity of S-nitrosoglutathione (GSNO); FIGS. 2 and 3 labeled (2) forExample 2) and Table 6.

In all the irradiations of Example 2, the level of specific impurity GSHand GSSG and total impurities increased in a small temperature, time anddose level dependent manner, after e-beam and gamma radiation Table 2.

Discussion

The results of Examples 1 and 2 are summarized in Tables 3 and 4:

TABLE 3 Summary of results for e-beam radiation [(1) = Example 1; (2) =Example 2] Conditions Example 1 Example 2 Example 1 Example 2 Dose level35 kGy 15 kGy Vial type Clear Amber Clear Amber Time of ~30 minutes Fewseconds 10-15 Few seconds irradiation minutes Temperature ~27.5 −80<27.5 ~27.5 −80 <27.5 (° C.) during irradiation GSNO purity −1.37 −0.55−1.12 −0.55 −0.16 −0.28 (decrease % of control)

TABLE 4 Summary of results for gamma radiation [(1) = Example 1; (2) =Example 2] Conditions Example 1 Example 2 Example 1 Example 2 Dose level35 kGy 15 kGy Time of 18-24 ~5 8-10 ~2 irradiation (hours) Temperature<60 −80 <32.5 <40 −80 <27.5 (° C.) during irradiation GSNO purity −9.45−1.01 −2.2 −4.47 −0.26 −0.67 (decrease % of control)

The above results show that optimised specific conditions exist tosterilise pharmaceutical S-nitrosothiols such as, for example,S-nitrosoglutathione. The decomposition of S-nitrosoglutathione in vialswas examined following irradiation (by e-beam and gamma) at two doselevels (15 kGy and 35 kGy) using different conditions (different vials,different duration and temperature of irradiation) in two differentexperiments. These studies confirm that ionising radiation can decomposeS-nitrosoglutathione; however they demonstrate, for the first time, thatspecific conditions of temperature and irradiation time and dose canminimise its decomposition, enabling the fulfilment of pharmaceuticalregulatory requirements. E-beam radiation appears to decomposeS-nitrosoglutathione less than gamma radiation at a parity of dosage.Decomposition is minimised by lowering the temperature and shorteningthe duration of the irradiation.

The foregoing broadly describes the present invention withoutlimitation. Variations and modifications as will be readily apparent tothose skilled in the art are intended to be covered. The scope ofprotection of the present invention shall be determined by reference tothe appended claims as properly construed according to law.

REFERENCES

The literature references in the foregoing description of the inventionare as follows:

Ahn D U, Lee E J (2002). Production of off-odor volatiles fromliposome-containing aminoacid homopolymers by irradiation. J Food Sci67: 7.Al-Sa'doni H, Ferro A (2000). S-Nitrosothiols: a class of nitricoxide-donor drugs. Clin Sci (Lond) 98: 507-520.Butler A R, Rhodes P (1997). Chemistry, analysis, and biological rolesof S-nitrosothiols. Anal Biochem 249: 1-9.

Hart T W (1985). Tetrahedron Letters, 26(16), 1985, 2013 to 2016.

Keaney J F, Jr., Simon D I, Stamler J S, Jaraki O, Scharfstein J, Vita JA, et al. (1993). NO forms an adduct with serum albumin that hasendothelium-derived relaxing factor-like properties. J Clin Invest 91:1582-1589.Lin C-E, Garvey D S (2005). Identification of the nitrate produced fromgamma-radiation sterilization of S-Nitrosoglutathione. Abstract ANYL174,General Papers 1.00 pm to 9.00 pm, 28 Aug. 2005, Hall A Poster, 230^(th)ACS Meeting, Washington D.C., 28 Aug.-1 Sep. 2005.Looker D, Beyer W (2008). WO 2008/153762 A2 S-nitrosothiol formulationsand storage systems.Manoj V M, Aravind Usha K, Aravindakumar C T (2009). Decomposition ofS-Nitrosothiols Induced by UV and Sunlight. Advances in PhysicalChemistry 2009: 6.Parent M, Dahboul F, Schneider R, Clarot I, Maincent P, Leroy P, et al.(2013). A Complete Physicochemical Identity Card ofS-nitrosoglutathione. Current Pharmaceutical Analysis 9: 12.Radomski M W, Rees D D, Dutra A, Moncada S (1992). S-nitroso-glutathioneinhibits platelet activation in vitro and in vivo. Br J Pharmacol 107:745-749.Rees D D, Palmer R M, Moncada S (1989a). Role of endothelium-derivednitric oxide in the regulation of blood pressure. Proc Natl Acad Sci USA86: 3375-3378.Rees D D, Higgs A, Moncada S (2001). Nitric Oxide and the Vessel Wall.In: Wilkins L W (ed). Hemostasis and Thrombosis, edn. p{circumflex over( )} pp 10.Rees D D, Palmer R M, Hodson H F, Moncada S (1989b). A specificinhibitor of nitric oxide formation from L-arginine attenuatesendothelium-dependent relaxation. Br J Pharmacol 96: 418-424.Singh R J, Hogg N, Joseph J, Kalyanaraman B (1995). Photosensitizeddecomposition of S-nitrosothiols and 2-methyl-2-nitrosopropane. Possibleuse for site-directed nitric oxide production. FEBS Lett 360: 47-51.Singh R J, Hogg N, Joseph J, Kalyanaraman B (1996a). Mechanism of nitricoxide release from S-nitrosothiols. J Biol Chem 271: 18596-18603.Singh S P, Wishnok J S, Keshive M, Deen W M, Tannenbaum S R (1996b). Thechemistry of the S-nitrosoglutathione/glutathione system. Proc Natl AcadSci USA 93: 14428-14433.Stamler J S, Toone E J (2002). The decomposition of thionitrites.Current opinion in chemical biology 6: 779-785.Stamler J S, Jaraki O, Osborne J, Simon D I, Keaney J, Vita J, et al.(1992). Nitric oxide circulates in mammalian plasma primarily as anS-nitroso adduct of serum albumin. Proc Natl Acad Sci USA 89: 7674-7677.

1. A sterile S-nitrosothiol or a sterile pharmaceutical pre-compositioncomprising S-nitrosothiol, wherein the S-nitrosothiol is in dry solidform and the sterile S-nitrosothiol or sterile pharmaceuticalpre-composition has an S-nitrosothiol purity of at least about 95% and asterility assurance level (SAL) of 10⁻⁶ or lower.
 2. The sterileS-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol of claim 1, wherein the sterile S-nitrosothiol or thesterile pharmaceutical pre-composition comprising S-nitrosothiol is in adry sterile environment in a sealed container.
 3. The sterileS-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol of claim 2, wherein the seal is arranged so that thecontainer can be opened, for example pierced, under sterile conditionsto allow the sterile S-nitrosothiol or a sterile pharmaceuticalpre-composition comprising S-nitrosothiol to be formulated with otherdesired ingredients to make a final pharmaceutical composition foradministration.
 4. The sterile S-nitrosothiol or sterile pharmaceuticalpre-composition comprising S-nitrosothiol of claim 2, wherein the sealis arranged so that a sterile liquid can be introduced into thecontainer, for example using a syringe provided with a hollow needle, todissolve or suspend the sterile dry solid S-nitrosothiol or the sterilepharmaceutical pre-composition in situ within the container.
 5. Thesterile S-nitrosothiol or sterile pharmaceutical pre-compositioncomprising S-nitrosothiol of claim 1, wherein the said material has beensterilised by exposure to a sterilising dose of ionising radiation in anenvironment sealed from external contamination.
 6. The sterileS-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol of claim 2, wherein the said material has been sterilisedby exposure to a sterilising dose of ionising radiation in the saidsealed container.
 7. The sterile S-nitrosothiol or sterilepharmaceutical pre-composition comprising S-nitrosothiol of claim 1,wherein the S-nitrosothiol has an S-nitrosothiol purity of at leastabout 98.0%, for example at least about 98.5%.
 8. The sterileS-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol of claim 1, wherein the amount of the S-nitrosothiol orthe pharmaceutical pre-composition comprising S-nitrosothiol contains aknown weight of S-nitrosothiol selected according to an ultimate desiredmedical use.
 9. The sterile S-nitrosothiol or sterile pharmaceuticalpre-composition comprising S-nitrosothiol of claim 1, wherein theS-nitrosothiol is selected from: S-nitrosoglutathione (GSNO);S-nitroso-L-cysteine (CySNO); S-nitroso-N-acetyl-cysteine (SNAC);S-nitroso-L-cysteinemethyl-ester (CMESNO); S-nitroso-D,L-penicillamine(PSNO); S-nitroso-N-acetyl-D,L-penicillamine (SNAP);S-nitroso-N-acetylcysteamine (ACSNO); S-nitroso-beta-mercaptosuccinicacid; 1-S-nitrosothio-beta-D-galactopyranose; S-nitrosothioglycerol;S-nitrosohomocysteine; S-nitrosocysteinylglycine; S-nitrosocaptopril;alkyl, cycloalkyl or aryl thionitrites, such as, for example, methylthionitrite, ethyl thionitrite, n-propyl thionitrite, s-propylthionitrite, n-butyl thionitrite, s-butyl thionitrite, tert-butylthionitrite, n-pentyl thionitrite, n-hexyl thionitrite, cyclohexylthionitrite, phenyl thionitrite; S-nitroso derivatives ofcysteine-containing proteins, oligo- and poly-peptides, for exampleS-nitrosoalbumin, poly-S-nitrosoalbumin or S-nitrosohemoglobin; and anyderivative thereof; and a salt of any of the foregoing.
 10. The sterileS-nitrosothiol or sterile pharmaceutical pre-composition comprisingS-nitrosothiol of claim 1, wherein the S-nitrosothiol isS-nitrosoglutathione.
 11. A kit comprising a container or containerscontaining sterile the sterile S-nitrosothiol or sterile pharmaceuticalpre-composition comprising S-nitrosothiol of claim 1, together withinstructions for mixing the sterile S-nitrosothiol or a sterilepharmaceutical pre-composition comprising S-nitrosothiol with one ormore sterile pharmaceutical diluents, excipients, carriers, additionalactive agents, or any combination thereof, to obtain a pharmaceuticalcomposition for a pharmaceutical use containing S-nitrosothiol in adesired concentration.
 12. A method for preparing a sterilepharmaceutical composition for human or veterinary use, comprisingmixing the sterile S-nitrosothiol or sterile pre-composition containingS-nitrosothiol of claim 1 with one or more sterile pharmaceuticaldiluents, excipients, carriers, additional active agents, or anycombination thereof, to obtain a pharmaceutical composition for apharmaceutical use containing S-nitrosothiol in a desired concentration.13. A pharmaceutical composition comprising a desired concentration ofthe sterile S-nitrosothiol or sterile pharmaceutical pre-compositioncomprising S-nitrosothiol of claim 1 mixed with one or more sterilepharmaceutical diluents, excipients, carriers, additional active agents,or any combination thereof.
 14. A method of treating or preventing adisease or disorder of a human or animal subject which responds toS-nitrosothiol or NO therapy, said method comprising administering thesterile S-nitrosothiol or sterile pharmaceutical pre-compositioncomprising S-nitrosothiol of claim 1, to a human or animal subject inneed thereof.
 15. The method of claim 14, the method comprisingadministering a pharmaceutical composition comprising the sterileS-nitrosothiol or sterile pre-composition containing S-nitrosothiolmixed with one or more sterile pharmaceutical diluents, excipients,carriers, additional active agents, or any combination thereof.
 16. Themethod of claim 14, wherein the sterile S-nitrosothiol or a sterilepharmaceutical pre-composition comprising S-nitrosothiol results ininducing arterial or venous smooth muscle relaxation, reducingaugmentation index, reducing augmentation pressure, reducing arterialstiffness, inhibiting platelet aggregation, inducing T cell apoptosis oractivating guanylate cyclase in the human or animal subject in needthereof.
 17. The method of claim 14, wherein the disease or disorderwhich responds to S-nitrosothiol or NO therapy is selected frompre-eclampsia, severe pre-eclampsia, eclampsia, HELLP syndrome, organtransplantation perfusion, organ dialysis, post-operative conditions ofballoon angioplasty, acute myocardial infarction, unstable angina,cerebral embolism, hypertension, atherosclerosis, restenosis, ischemiaand heart failure, other cardiovascular proliferative, inflammatory,contractile and hypertensive disorders, and pre-conditioning relateddisorders of the heart and brain, oesophageal spasm, biliary spasm,colic and other motility and smooth muscle disorders of thegastrointestinal tract, erectile dysfunction, stroke, bronchialconstriction, cystic fibrosis, pneumonia, asthma, pulmonary fibrosis,and other pulmonary disorders involving diminished gas exchange orinflammation, as well as infectious diseases of viral, bacterial andother origin, disorders of red blood cells characterised byS-nitrosothiol deficiency, abnormal rheology or impaired vasodilation,and thrombotic disorders.